Despite all these benefits, some groups are opposed to SEP-1. Below are some arguments made against SEP-1 along with Sepsis Alliance’s rebuttals.
The Argument: Opponents argue that SEP-1’s quick treatment with antimicrobials contributes to the growing problem of antimicrobial resistance (AMR). AMR occurs when specific strains of bacteria, viruses, fungi, or parasites adapt in order to avoid medicines designed to treat them. SEP-1’s opponents argue that when clinicians are encouraged to administer drugs very quickly, they don’t have time to correctly identify which drugs, if any, are needed, therefore contributing to overuse and resistance.
Our Response: SEP-1 only dictates when a first dose of antimicrobials should be given. By the time a second dose might be appropriate, clinicians usually have had time to get a more complete picture of the patient and can adjust the course of treatment as necessary. This discourages antimicrobial overuse and resistance while still encouraging clinicians to give drugs quickly to patients who may desperately need them.
The Argument: Opponents argue that early antimicrobials save more patients with septic shock than patients with sepsis—and that, therefore, early treatment is not necessary for everyone.
Our Response: A larger fraction of septic shock patients can be saved by early antibiotics, but that is simply because patients are more likely to die once they have progressed to septic shock. Studies show that early antibiotics for patients with infection or sepsis can prevent those patients from progressing to septic shock and can save lives.
The Argument: Opponents argue that the process is tricky to implement in hospitals because it has many steps and requires extra personnel to track those steps.
Our Response: Many who argue that SEP-1 is tricky to implement may be responding to difficulty diagnosing sepsis. The SEP-1 treatment steps need to be achieved within a short window of time once sepsis is suspected, and sepsis diagnosis can be complex. With training, diagnosing sepsis becomes easier and the timing of treatments improves. Processes like SEP-1 also become easier to implement over time as they become a routine part of hospital operations. Studies show that as hospitals assign personnel and develop procedures, these processes become increasingly able to “serve as a focus for improvement strategies.”
The Argument: Opponents argue that not all sepsis patients need the amount (30mL/kg) of intravenous fluid recommended by SEP-1.
Our Response: We know that not all patients with sepsis need this amount of IV fluid for resuscitation, and there are acceptable ways to determine which patients need that volume of fluid and which do not. SEP-1 merely requires that providers document their clinical reasoning if they choose to administer less than the recommended amount; it does not require that every patient receives that quantity of IV fluid. Having a standard operating procedure—including what to do when there is a reason not to follow a recommendation—ensures the best care for the most people.
The Argument: Opponents argue that SEP-1 encourages diagnosing sepsis in patients who are not severely ill, and that the reduction in mortality shown in studies is simply due to treating less sick patients earlier.
Our Response: SEP-1 does encourage diagnosing sepsis in patients who are less ill. As people who could some day be patients with sepsis, we find it hard to see what is wrong with encouraging intervention before things get worse. That philosophy applies to any disease, but it is very poignant when applied to sepsis, the leading cost of care and cause of death in U.S. hospitals.